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Intra-Articular Repair for

Cranial Cruciate Ligament

Rupture in the Dog

Jeffery J. Biskupand Michael G. Conzemius

Introduction

Cruciate ligament rupture (CR) is one of the
most common orthopaedic conditions seen in
small animal medicine, but an ideal repair has
not yet been elucidated (Johnsonet al. 1994;
Bellumoriet al. 2013; Krotschecket al.2016).
Although successful treatment of CR has been
achieved both medically and surgically, recent
evidence suggests that outcomes are optimized
in dogs after surgical treatment (Wucherer
et al. 2013). This chapter first identifies some
potential limitations of commonly used sur-
gical procedures for CR, briefly explores the
historic use of intra-articular repair in dogs,
and then focuses on overcoming the identi-
fied limitations of both extra- and intra-articular
repairs. Specifically, the limitations addressed
will include graft selection, graft fixation, and
graft biology.

Current cruciate ligament rupture

surgical treatment outcomes

Surgery for CR has been shown to greatly
improve lameness but may not consistently
get patients back to normal (Mols ̈ ̈a et al.
2013; Wucherer et al. 2013). Current tibial

osteotomy stabilization methods have high suc-

cess rates at early and mid-range follow-up

times, but outcome measures are often sub-

jective, such as non-validated owner question-

naires (Hoffmanet al. 2006; Corr & Brown 2007;

Stein & Schmoekel 2008) and veterinarians’

visual assessment (Waxmanet al. 2008). More

objective outcomes, such as force platform anal-

ysis, pressure platform analysis, radiographic

scoring and thigh circumference have been

used as more sensitive ways to assess lame-

ness after surgical treatment of CR (Jevens

et al. 1996; Conzemiuset al. 2005). With more

objective measurements, outcomes with tibial

osteotomies in certain studies have shown that

operated limbs do not obtain the same function

as normal limbs (Evanset al. 2005; Vosset al.

2008).

A final challenge when interpreting CR sur-

gical outcome studies is that standardized defi-

nitions of success and follow-up time have not

been agreed upon, and this makes the com-

parison of studies difficult. For example, one

study used a stringent definition of success

that combined both subjective and objective

outcomes, comparing medical management

to tibial plateau leveling osteotomy (TPLO)

(Wuchereret al. 2013). That study revealed a

Advances in the Canine Cranial Cruciate Ligament, Second Edition. Edited by Peter Muir. © 2018 ACVS Foundation.
This Work is a co-publication between the American College of Veterinary Surgeons Foundation and Wiley-Blackwell.

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